Bottom line: Molecular alteration testing used in clinical practice may reduce the number of unnecessary thyroid procedures and completion thyroidectomies, and may lead to more individualized operative and post-operative care.
Explore This IssueApril 2013
Citation: Witt RL, Ferris RL, Pribitkin EA, Sherman SI, Steward DL, Nikiforov YE. Diagnosis and management of differentiated thyroid cancer using molecular biology. Laryngoscope. 2013;123:1059-1064.
—Reviewed by Amy Eckner
Polysomnography Widely Used in Pediatrics, but Not Up to Practice Guidelines
How frequently do pediatric otolaryngologists use polysomnograms (PSG) in their practices for children with sleep-disordered breathing (SDB)?
Background: The American Academy of Pediatrics (AAP) published 2002 guidelines for management of snoring in children, with PSG as the gold standard of diagnosis for obstructive sleep apnea (OSA) and adenotonsillectomy as the first-line treatment. A 2004 survey of American Society of Pediatric Otolaryngology (ASPO) members showed that PSG was rarely requested.
Study design: A 20-question, five-minute cross-sectional survey was sent to ASPO members in June 2011.
Synopsis: The response rate for the survey was 39 percent (135/345), with three members opting out. The majority of respondents “sometimes” requested a PSG for children with suspected SDB (65 percent) and did not use home sleep testing (81 percent). The primary reason for requesting a PSG was inconsistent history and physical examination (58 percent). Comorbidities (obesity, 38 percent; Down syndrome, 56 percent; younger than 3 years, 22 percent) affected PSG requests. The median and mode for observation following an outpatient tonsillectomy were each three hours. PSG was less likely to be requested post-operatively for children with obesity or Down syndrome. Wait time for PSG was a significant factor in frequency of request: There was a 10.4 percent greater chance physicians would order a PSG for ever week of wait time for the PSG. At least 69 percent of respondents “sometimes” request a PSG; however, respondents were less likely to request a pre-operative PSG for children who are obese, have Down syndrome or are younger than 3 years. Access to a dedicated pediatric sleep lab has increased from 67 percent to 86 percent, and the current average wait for a sleep study is 5.7 weeks. Survey limitations include a relatively low response rate, variation in access to sleep laboratories and differences in ASPO member practices.
Bottom line: Although requests for PSG prior to tonsillectomy have increased, they are still not compliant with AAP or American Academy of Sleep Medicine guidelines.